pyrazinamide: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
pyrazinamide: clinical details
Prescribing considerations
- Use only as part of an effective multidrug tuberculosis regimen under specialist supervision.
- Review hepatic and renal function, alcohol intake, gout or hyperuricaemia history, diabetes, pregnancy and breastfeeding status before treatment.
- Consider susceptibility information and the risk of rapid resistance if companion medicines are ineffective.
- Warn about hepatotoxicity, photosensitivity and symptoms of acute gout.
Contraindications and cautions
- Hypersensitivity to pyrazinamide or an excipient
- Severe hepatic impairment or acute liver disease, including the product-specified period following hepatitis
- Acute porphyria
- Hyperuricaemia or acute gouty arthritis
- Breastfeeding according to the selected product licence
Monitoring
- Liver function before and during treatment, with prompt reassessment if hepatic symptoms develop
- Renal function before and during treatment
- Serum urate and symptoms of gout
- Glucose control in people with diabetes
- Adherence, adverse effects and effectiveness of the complete TB regimen
Clinical pharmacology
Pyrazinamide is an orally absorbed prodrug converted by mycobacterial pyrazinamidase to pyrazinoic acid. It is mainly metabolised hepatically, and metabolites are eliminated through the kidneys. Resistance commonly involves pncA or its promoter, preventing effective activation.
Formulation and product differences
- The selected product is an uncoated tablet containing lactose.
- Its score line is for appearance or easier swallowing, not for subdivision into part doses.
- Blister and bottle presentations are described; not all pack sizes may be marketed.
pyrazinamide preparations and strengths
Tablet
Route: Oral
Strengths: 500 mg
pyrazinamide interactions
The TB team should review prescribed, non-prescription and complementary products before treatment.
Alcohol and other potentially hepatotoxic substances
May increase the risk of liver injury and should be avoided or closely reviewed.
Probenecid or sulfinpyrazone
Pyrazinamide can oppose their urate-lowering effect, so gout control and serum urate may need closer review.
Glucose-lowering medicines
Blood glucose control may change, requiring closer monitoring in people with diabetes.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.